TITLE: Barriers and Facilitators to Implementation and Adoption of EHR in Home Care - Home care is an increasingly important and effective way of managing chronic illness with skilled nursing care in the home. Significant challenges set home care apart from care in hospital and ambulatory settings, such as a high level of team planning and communication among a disparate interdisciplinary team, insufficient information, and computer use in the demanding home environment. Relatively little is known about the impact of the growing use of electronic health records (EHR) in home care. Almost two-thirds of the 10,000 home care agencies have yet to adopt EHRs at the point-of-care. It is critical to understand the adoption, implementation, and "Meaningful Use" of EHRs in home care now in order to make best use of limited time, money, and energy to promote positive health outcomes. Meaningful use is the intended impact of EHRs to achieve health and efficiency goals. In 2009, Penn Care at Home implemented a point-of-care EHR that enabled clinicians to review patient charts and begin their care documentation while in the patient's home. The proposed research is innovative because it will fill a knowledge gap by focusing on EHR evaluation in home care and will use a strong research design for the HIT evaluation. Methods: (1) We hypothesize that implementation of point-of-care EHR will result in significant improvements in patient, workflow, and financial outcomes. We will evaluate this hypothesis by using an interrupted-time-series design. We will collect quantitative data including EHR usage, patient outcomes, clinical documentation completion, reimbursement, and clinician satisfaction and qualitative data including EHR functionality, clinician observations, and clinician interviews about satisfaction. (2) We will propose design and implementation recommendations for barriers and facilitators to adoption by combining quantitative and qualitative data in a mixed methods analysis. (3) We also will propose policy recommendations for EHR Meaningful Use in home care. The analysis will identify home care EHR functionality (e.g., view care plan) that differs from ambulatory EHR functionality identified in Meaningful Use objectives. Expected Outcomes: Outcomes for a point-of-care EHR in home care include: (1) description of patient, workflow, and financial impact on clinical process;(2) design and implementation recommendations;and (3) policy recommendations for Meaningful Use objectives in home care. This study will inform real world EHR design, adoption, and implementation decisions for home care EHR developers, decision makers, and policy makers. The research will also stimulate more effective EHR home care studies by strengthening the research approach and increasing the knowledge-base regarding EHR implementation and adoption. PUBLIC HEALTH RELEVANCE: Three million Medicare recipients receive nearly 104 million home care visits annually. The quality and efficiency of clinical care may be improved as home care agencies increase adoption of electronic health records clinicians use in their patients'homes. Nurses, therapists, and social workers can make better decisions when the health information they need is at hand and can be communicated among the clinical team. By assessing whether a widely used electronic health record helped clinicians provide better and more efficient health care, this project will inform electronic health record developers, home care agency decision makers, and national policymakers in electronic health record adoption and implementation in home care. PUBLIC HEALTH RELEVANCE: Three million Medicare recipients receive nearly 104 million home care visits annually. The quality and efficiency of clinical care may be improved by home care agencies increasing adoption of electronic health records used by clinicians in the patients'homes. Nurses, therapists, and social workers can make better decisions when the health information they need is at hand and can be communicated among the clinical team. By assessing whether a widely used electronic health record helped clinicians provide better and more efficient health care, this project will inform electronic health record developers, home care agency decision makers, and national policymakers in electronic health record adoption and implementation in home care.)